ADDICTION Flashcards
What is addiction
A disorder in which an individual takes a substance or engages in a behaviour that is pleasurable but eventually becomes compulsive with harmful consequences.
What 3 things is addiction marked by
Physiological and/or psychological dependence, tolerance and withdrawal
What is physical dependence
A state of the body due to habitual substance abuse which results in a withdrawal syndrome when use of the drug is reduced or stopped.
What is psychological dependence
A compulsion to continue taking a substance (or continue performing a behaviour) because its use is rewarding.
What is a consequence of psychological dependence
The person will keep taking the substance or engaging in a behaviour until it becomes a habit despite the harmful consequences
What is tolerance
A reduction in response to a substance, so that an addicted individual needs more to get the same effect.
What causes tolerance
Repeated exposure to the effects of a substance
What is behavioural tolerance
Give an example
It happens when an individual learns through experience to adjust their behaviour to compensate for the effects of a substance.
An alcoholic learns to walk slower so they dont fall when drunk.
What is cross-tolerance
Give an example
Developing a tolerance to one type of substance can reduce sensitivity to another type.
Alcohol and benzodiazepines
What is a risk factor
Any internal or external influence that increases the likelihood a person will start using addictive substances or engaging in addictive behaviours
Name the 5 risk factors for addiction
- Genetic vulnerability
- Stress
- Personality
- Family influences
- Peers
Explain how genetic vulnerability is a risk factor for addiction
People don inherit an addiction itself but a predisposition (vulnerability) to dependence.
Genes may determine the activity of neurotransmitter systems in the brain, which affect behaviours such as impulsivity which predispose a person to dependence.
Explain how stress is a risk factor for addiction
Does the stress have to be going on now
People who experience stress may turn to drugs as a form of self-medication
Stress includes present and past events
Explain how personality is a risk factor for addiction
Is there such thing as an ‘addictive personality’
Individual personality traits such as hostility and neuroticism may increase the risk of addiction.
Probably not.
Explain how family influences is a risk factor for addiction
Living in a family which uses addictive substances and/or has positive attitudes about addictions increases a person’s likelihood of becoming addicted
Explain how peers is a risk factor for addiction
As children get older, peer relationships become more important, even more than family.
Even if you dont use the drug your attitude towards them may be influenced
What is one limitation to risk factors
By focusing on one individual risk factor you may ignore the effect of interactions and also the positive effects.
Does one risk facto cause addictions
No
Combinations of risk matter more than single factors.
Who researched combinations of risk factors
Linda Mayes and Nancy Suchman (2006)
What did Mayes and Suchman conclude about combinations of risk factors
Different combinations partly determine the nature and severity of an addiction.
Are all of the risk factors mentioned always negative
Explain
Which risk factor is never positive
No
Personality traits, genetic characteristics, family and peer influences can reduce risks of addiction.
Stress
What is a more realistic way to view risk factors
View risk factors as multiple ‘pathways’ to addiction which include different combinations interacting and some having a positive effect.
What is one strength of looking at risk factors together
They point to the overriding interaction with genes.
Most risk factors are proximate. What does this mean
Example
They act as an immediate influence on addiction
High stress levels directly increase addiction risk as does the personality trade of novelty-seeking.
Who conducted research on the central tole of genes in addiction
Rey et al. (2009)
What did Rey et al. Conclude on the central role of genes in addiction
How we respond to stress and the extent to which we seek novelty are both partly genetic.
What is the most common ultimate risk factor
Genetic vulnerability.
What is withdrawal syndrome
A set of symptoms that develop when an addicted person abstains from or reduces their substance abuse.
Are withdrawal symptoms the same for all drugs
Are withdrawal symptoms predictable
No
Yes
What is the common link between substance and withdrawal symptoms
Give an example
The symptoms are almost always the opposite of the ones created by the substance
Smoking relaxes you so when you stop anxiety is heightened
Give an example of an active ingredient
Nicotine
Alcohol
What does the existence of withdrawal indicate
Physical dependence has developed
Why does withdrawal symptoms cause further addiction
An addicted person experiences withdrawal whenever they dont have the addictive substance
These withdrawal symptoms are unpleasant and cause discomfort
Motivation to continue with the drug is avoidance of withdrawal syndrome
Taking a substance to avoid withdrawal syndrome is called
A secondary form of psychological dependence
Name the two phases of withdrawal
- The acute withdrawal
- The prolonged withdrawal
How long does acute withdrawal last
Begins within hours
Deminished over days
How long does the prolonged withdrawal phase last
Weeks, months and even years
What are the symptoms of acute withdrawal
Intense cravings reflecting strong physiological and psychological dependence
What are the symptoms for prolonged withdrawal phase
Example
What does this mean
The person becomes highly sensitive to the cues they associate with the substance.
E.g. lighters, rituals, locations
This is why relapse is so common.
What type of dependence does withdrawal indicate
Physical dependence
What are the two plausible direct mechanisms that create a genetic vulnerability to addiction
D2 receptor
Nicotine enzyme (CYP2A6)
Explain how dopamine transmission is effected
What is this controlled by
By the number of dopamine receptors
This number is genetically controlled
What type of receptor is D2
A Dopamine receptor
What is the correlation between D2 and addiction
Explain how it leads to addiction
People who are addicted have been found to have an abnormally low number of D2 receptors.
Fewer receptors means less dopamine activity, so using drugs is a way of compensating for this deficiency
Who researched Nicotine enzyme CYP2A6
Micheal Pianezza et al. (1998)
What did Micheal Pianezza et al. Find out about the enzyme CYP2A6
What does this mean for addiction
Some people lack a fully functioning enzyme which metabolises nicotine.
These people smoke significantly less than those smokers with the fully functioning version.
What is the nicotine enzymes scientific name
CYP2A6
What is the expression of the CYP2A6 enzyme determined by
Genetics
Who highlighted the role of adverse childhood experiences in later addiction
Susan Andersen and Martin Teicher (2008)
What does ACEs stand for
Adverse Childhood Experiences
What do Anderson and Teicher argue about stress and ACEs
Early experiences of severe stress have damaging effects on a young brain n a sensitive period of development.
This creates vulnerability to later stress.
How does Andersen and Teichers argument link to addiction
Further experiences in adolescence and adulthood trigger the early vulnerability and make it more likely that a person will self-medicate with drugs or other behavioural addictions
Is there such thing as a generally addictive personality
What type of personality is linked to addiction
No
Linked to disordered personality.
What disorder is linked mostly to addiction
Who says this
Antisocial personality disorder (APD)
Petry (2002)
Who argues that APD is a causal risk for addiction
Lee Robins (1998)
What is Lee Robins argument for APD and addition
That APD is a causal risk factor because having APD means that a person breaks social mores, is impulsive and may behave criminally
Why will people with APD try drugs
When are they most likely to do it
Drug-taking offers a combination of norm-breaking, criminal activity whist satisfying desires
At a young age
What is the study for family influences on addiction
Jennifer Livingston et al. (2010)
What did Jennifer Livingston find on family influences and addiction to alcohol
Final-year high-school students who were allowed to drink alcohol at home were significantly more likely to drink excessively the following year at college.
What role does adolescent’s perception play in addiction
Adolescents who believe that their parents have little or no interest in monitoring their behaviour are more likely to develop an addiction.
Who suggested that there are 3 major elements to peer influence a s a risk factor for alcohol addiction
Mary O’Connell et al. (2009)
What are the 3 major elements to peer influence as a risk factor for alcohol addiction
- An at-risk adolescent’s attitude and norms about drinking are influences by associating with peers who use alcohol.
- Experienced peers provide more opportunities for the at-risk individual to drink
- An individual overestimates the amount their peers are drinking, they drink more to keep up with the perceived norm
What is the underlying matter of peers and addiction
A group normally that favours rule-breaking generally
Substance addiction is one instance of this
What is a strength of genetic vulnerability as a risk factor for addiction
Support from adoption studies
Who carried out the adoption studies focusing on genetic vulnerability for addiction
Kenneth Kendler et al. (2012)
What was Kendlers method when investigating adoptive studies and addiction
He used data from the National Swedish Adoption Study.
They looked specifically at adults who had been adopted away, as children, from biological families in which as least one parent had addiction.
What was Kendlers findings on genetic vulnerability and addiction
The children later has a significantly greater risk of developing an addiction themselves, compared with adopted-away individuals with no addicted biological parent.
What other research supports the link between genetic vulnerability and addiction
Twin studies
What is one limitation of reserach into stress as a risk factor for addiction
The issue of causation
What have many studies show about the link between stressful experiences and addiction
That there is a positive correlation
What is the key matter for stress as a risk factor for addiction
Explain via example
It matters whether stress or addiction comes first
Some people become addicted with not a significantly stressful experience. Their addiction causes greater levels of stress due to negative effects.
This would still produce a positive correlation but addiction caused the stress.
What is one strength of personality as a risk factor for addiction
Support for the link between addiction adn APD
What link between APD and alcohol dependence is shown in many studies
That they are co-morbid
Who investigated whether APD is actually a causal factor for addiction
Miriam Bahlmann et al. (2002)
What was Bahlmann’s method for investigating APD and addiction
They interviewed 55 alcohol-dependent people
What was Bahlmann’s findings on alcohol addiction and APD
Of 55 interviewed 18 weer also diagnosed with APD.
For these 18 participants APD developed 4 years before their alcohol addiction on average.
What is one strength for family influence as a risk factor for addiction
Research support
Who investigated family influences as a cause for addiction
Bertha Madras et al (2019)
What was Madras findings on family influences as a risk factor for addiction
Found a strong positive correlation between parents use (abuse) of cannabis and their adolescents use of cannabis, nicotine, alcohol and opioids.
What are the two reasons behind family influences leading to addiction
May be that adolescents observe their parents using a specific drug and model this behaviour.
May also infer that their parents approve of drug use, so go on to use other drugs.
What is one strength of peers as a risk factor for addiction
Real-world application
Who is doing an intervention to change mistaken beliefs about how much peers are drinking
SNMA
Social Norms Marketing Advertising
What is SNMA doing to change mistaken beliefs on how much peers drink
Examples with fact
Using mass media advertising to provide messages and statistics about how much people really drink
Beer mats, posters and leaflets in a Student Union bar with messages such as ‘Students overestimate what others drink by 44%’
What is neurochemistry
Relating to chemicals in the brain that regulate biological and psychological functioning
What is dopamine
A neurotransmitter that generally has an excitatory effect and is associated with the sensation of pleasure
Who came up with the desensitisation hypothesis of nicotine addiction
John Dani and Steve Heinemann (1996)
What neurotransmitter plays a key role in all nervous system activity and is key in the role of dopamine
Acetylcholine (ACh)
Where can ACh receptors be found
On the surface of many neurons in the central nervous system
What is the subtype of ACh receptor called
Nicotinic acetylcholine receptor (nAChR)
What is special about nAChR receptors
They can be activated by both dopamine and nicotine
What occurs at the nAChRs when a person smokes
When nAChRs are activated by nicotine molecules, the neuron transmits dopamine.
This is immediately followed by a shutdown.
Within seconds the nAChRs shut down and temporarily cannot respond to any neurotransmitters.
The neurone is desensitised and this leads to downregulation, a reduction in the number of active neurons because fewer of them are avaliable.
What is a desensitised neuron
One that is shutdown and temporarily cannot respond to any neurotransmitters
What is downregulation
A reduction in the number of active neuron’s because fewer of them are avaliable
Where are nAChRs concentrated
In the ventral tegmental area (VTA) of the brain.
When nAChRs are stimulated by nicotine how and where is dopamine transmitted
Dopamine is transmitted along the Mesolimbic pathway
To the Nucleus accumbens (NA)
What does the movement of dopamine into the Nucleus Accumbens trigger
The release of more dopamine from the Nucelus Accumbens into the Frontal Cortex
When dopamine is being transmitted along the mesolimbic pathway where else is it being transmitted to and how
Directly to the frontal cortex
On the mesocortical pathway
Name both the pathways to the frontal cortex and where the dopamine is flowing from in the brain
Ventral tegmental area ——mesolimbic pathway——> Nucelus accumbens ——> Frontal Cortex
Ventral tegmental area ——Mesocorical Pathway——> Frontal Cortex
What are both of the pathways part of
The dopamine reward system
What activates the dopamine reward system
Nicotine
What are the pleasurable effects of nicotine
Mild euphoria, increased alertness, reduction of anxiety
What happens to nicotine and nAChRs and dopamine neurons when someone doesnt smoke for a long period of time
- KEY WORDS
Nicotine disappears from their body
The nAChRs become functional again, so dopamine neuron’s resensitise and more become available
Upregulation
What is upregulation
The nAChRs become functional again, so dopamine neuron’s resensitise and more become available
Explain withdrawal in terms of nAChRs
During resensitisation nAChRs become over stimulated by ACh - as there is no nicotine to bind
NAChRs are most sensative at this point
When are nAChRs most sensative
During resensitisation
Why is the first cigarette of the day most enjoyable
It reactivates the dopamine reward system
Describe dependence in terms of nAChRs
Do so through night-time and day-time changes
There is a constant cycle of daytime downregulation and night-time upregulation.
This causes longterm desensitisation of nAChRs - causing dependence.
Describe tolerance in terms of nAChRs
Continuous exposure of nAChRs to nicotine causes permanent changes to brain neurochemistry
It decreases the number of active receptors.
Tolerance therefore develops as a smoker must smoke more to get the same effects.
What is one strength of dopamine explanations of nicotine addiction
Support from human research
Who has conducted research that supports dopamines explanation of nicotine addiction
Joseph McEvoy et al. (1995)
What did McEvoy study - dopamine explanations of nicotine addiction
Method
Studied smoking behaviour in people with schizophrenia where were taking the antipsychotic drug Haloperidol.
In McEvoy’s study why did he focus on schizophrenia patients taking Haloperidol
Haloperidol is a dopamine antagonist - blocks dopamine receptors in the brain, reducing dopamine transmissions
What was McEvoy’s findings in his reserach on smoking behaviour in people with schizophrenia
Explain
The people taking Haloperidol showed a significant increase in smoking.
This is a form of self-medication.
Individuals used the nicotine as a means of increasing their depleted dopamine levels.
What is a counterpoint to research support for dopamine explanations of nicotine addiction
Explanations of nicotine that consider only the role of dopamine are limited.
The dopamine system is central but research increasingly shows a complex interaction of several neurochemical systems
Why did research on the other neurochemical systems that may be involved in nicotine addiction
Shelley Watkins et al. (2000)
What did Watkins say the other neurochemical systems are
Neurotransmitter pathways e.g. serotonin
Endogenous opioids (endorphins)
What is another strength that neurochemistry does
Leads to new treatments
Give an example of neurochemistry leading to new treatments
Nicotine replacement therapy (NRT)
Name 3 examples of NRT
Patches
Gum
Inhalers
How do Nicotine Replacement Therapies work (NRT)
They deliver controlled doses of nicotine
Acts neurochemical by binding with nAChRs and mimicking the effects of nicotine, including dopamine release.
Satisfies cravings and allows safe withdrawal.
What is the limitation of the neurochemical explanation
It does not fully explain withdrawal
What do withdrawal symptoms mainly depend upon
The nicotine blood concentration levels in the body.
Who is the study for neurochemical explanations not fully explaining withdrawl
David Gilbert (1995)
What did Gilbert point out about withdrawal not being fully explained by neurochemistry
Blood level concentrations do not strongly correlate with the severity of withdrawal symptoms.
What did Gilbert argue instead about what withdrawal depends upon
Example
Withdrawal depends much more on environment and personality.
Those who score higher on the personality dimension of neuroticism generally experience worse withdrawal symptoms than those who are emotionally stable/
Who states that some people can smoke without becoming dependent or experience withdrawal
Shipman and Paty (2006)
What did shipman and patty state
What is this called
Some people smoke without becoming dependent and show no signs of withdrawal
Determinism
Why does shipman and pattys statement contradict the neurochemical explanation for nicotine addiction
The neurochemical explanation is biologically determinist suggesting we become addicted due to chemical events.
It suggests nicotine addiction is inevitable.
What is the learning theory
A behaviourist explanation based on the mechanisms of classical and operant conditioning such as positive and negative reinforcement.
What type of conditioning is cue reactivity an example of
Classical conditioning
Is nicotine a strong reinforcer
Yes
Explain how nicotine is a positive reinforcement
Nicotine stimulates the dopamine reward system.
When someone has a cigarette they experience mild euphoria which the smoker finds rewarding and positively reinforces their smoking behaviour.
Who stated that positive reinforcement can explain the early stages of smoking
George Koob and Michel Le Moal (2008)
What stage of smoking is positive reinforcement involved in
The early stages of
What stage of smoking is negative reinforcement
A smoker’s continuing dependence on nicotine
Explain how negative reinforcement plays a role in smoking
Negative withdrawal symptoms occur when a smoker stops smoking.
The smoker smokes another cigarette which is negative reinforcing because it stops an unpleasant stimulus.
What are the pleasurable effects of smoking known as
A primary reinforcer
Why are the pleasurable effects of smoking known as a primary reinforcer
It is intrinsically rewarding (not learned) due to its effects on the brain’s dopamine reward system
What are secondary reinforcers
Any other stimuli that is present at the same time or just before that become associated with this pleasurable effect.
Give examples of secondary reinforcers for smoking
Areas such as pub gardens or smoking areas
Friends who also smoke
Smell of tobacco
A favourite lighter
What do all secondary reinforcers act as?
Why
Cues
Because their presence produces a similar physiological and psychological response to nicotine itself.
What are the three main elements of cue reactivity?
- Subject desire or craving for a cigarette, which is self-reported
- Physiological signs of reactivity, including autonomic responses such as heart rate and skin temperature
- Objective behavioural indicators such as how many ‘draws’ are taken on a cigarette and how strongly
What is the definition of cue reactivity
Cravings and arousal can be triggered in, for instance, nicotine addicts when they encounter cues related to the pleasurable effects of smoking.
What is one strength for the learning approach to addiction
Support through animal studies
There is a substantial body of research with non-human animals confirming the role of operant conditioning in nicotine addiction
Who completed a study on operant condition and nicotine addiction
Edward Levin et al. (2010)
What was the method to Levins research on operant conditioning
Rats could lick two water spouts.
Licking one spout caused an intravenous dose of nicotine.
What was Levins results on his research with rats on operant conditioning and nicotine addiction
The rats licked the nicotine-linked waterspout significantly more than often.
The number of licks increased over 24 hrs.
What are the limitations to Levis research on operant conditions and nicotine addiction
Human-animal comparisons are flawed because nicotine addiction in humans is more complex due to cognitive factors.
Ethical issues with using animals for experimentation.
What is the positive of using animals in research on conditioning and nicotine addiction
The conditioning mechanisms involved in nicotine addiction are the same in humans and other mammals (according to behaviourists)
More ethical to use animals over humans.
What is a strength for cue reactivity and its link to nicotine addiction
There is research with humans for the effects of
Who conducted a meta-analysis on cue reactivity in humans for nicotine addiction
Brian Carter and Stephen Tiffany (1999)
What did Carter and Tiffany do in their research on cue reactivity and nicotine addiction
What did studies involve
Conducted a meta-analysis of 41 studies into cue reactivity
The studies presented dependent, non-dependent and non smokers with images of smoking-related cues.
What was measured in the studies in the meta-analysis conducted by Carter and Tiffany
Self-report desire was measured along with indicators of physiological arousal (heart rate)
What was the results of Carter and Tiffany’s meta-analysis on cue reactivity and addiction
Dependent smokers reacted most strongly to the cues and reported stronger cravings even when nicotine wasn’t present.
What strength does nicotine treatment programmes prove
They are based on classical conditioning principles.
What does aversion therapy use to treat nicotine addiction
Countercondition
What therapy uses counterconditoning to treat nicotine addiction
Aversion therapy
How is counterconditioning done to treat nicotine addiction
It associated the pleasant effects of smoking with an aversive stimuli e.g. an electric shock
Who researched aversion therapy for nicotine addiction
What was the method
James Smith (1988)
Smokers gave themselves aversive electric shocks whenever they engaged in any smoking-related behaviours
What was the results of smiths research on counterconditioning
Compare this to the usual rates (2 Facts)
After one year 52% of the participants were still abstaining.
Usually 20-25% of people continue not to smoke after deciding to give up.
What is the counterpoint to Smith’s research on counterconditioning as a treatment for nicotine addiction
The study did not use a control (placebo) group.
The comparison of the proportion of people who continue not to smoke is not a valid measure of effectiveness.
Who provided evidence in a higher-quality study that the benefits of aversion therapy are relatively short-lived compared to other therapies
Hajek and Stead (2001)
What is the negative to aversion therapies compared to others
It has a shorter temporal effect.
What is reinforcement
A consequence of behaviour that increases the likelihood of that behaviour being repeated.
Can be positive or negative
What is the first component in the learning theory of gambling addiction
Vicarious reinforcement
Seeing others be rewarded for their gambling through pleasure, enjoyment and money.
What are the two sources of direct positive reinforcement for gambling
Winning money
The adrenaline rush that accompanies a gamble
Explain how gambling can have a negative reinforcement
It can be a distraction from aversive stimuli
A distraction from the anxieties of everyday life
What is the overall specific types of reinforcement seen in gambling
Partial reinforcement
What is partial reinforcement
A behaviour is reinforced only some of the time it occurs
E.g. every tenth time or at variable intervals
What is a sub type of partial reinforcement
Variable reinforcement